Rates of diabetes-related amputation vary across U.S.
NEW YORK (Reuters Health) - Rates of foot and leg amputations among Americans with diabetes may vary widely according to where they live, a new study suggests.
One recent study found that the rate of amputation may be declining among Americans with diabetes. But the new findings, reported in the journal diabetes Care, suggest that in some parts of the country that rate can be almost double the national average -- at least among older Americans.
The current study found that in 2008, certain pockets of Arkansas, Louisiana, Mississippi, Oklahoma, and Texas had the highest rates of diabetes-related amputation among Medicare beneficiaries -- at about 7 to 8 per 1,000.
That compared with a national rate of 4.5 per 1,000 in the same year. And certain locations -- like portions of Arizona, Florida, Michigan, and New Mexico -- had particularly low rates. There, older adults with diabetes had amputations at a rate of 2.4 to 3.5 per 1,000.
"The rate of amputation really varies greatly," said lead researcher Dr. David J. Margolis, of the University of Pennsylvania in Philadelphia. "We don't know why that is, we just know that it's there."
The researchers were able to account for some factors -- like the prevalence of diabetes in a given area, the number of people diagnosed with diabetic foot ulcers, and an area's income and racial mix. That explained some of the geographical variation, Dr. Margolis told Reuters Health, but not all of it.
He cautioned that the relatively high rates of amputation in certain regions do not necessarily mean the rates are "too high." It's possible, for example, that doctors in those areas see more people with severe diabetes complications and based on experience, have found that an earlier amputation is often better.
There are no general guidelines on when to do an amputation in someone with severe diabetic ulcers, so it's up to the doctor's judgment and what the patient wants.
"It's not a clear-cut decision," Dr. Margolis noted.
The findings are based on data from Medicare for the years 2006 to 2008.
More research is now needed to understand the reasons for the variations among Medicare beneficiaries, Dr. Margolis said. For now, people with diabetes can take steps to protect their limbs, he noted.
Experts recommend that people with diabetes check their feet everyday to catch cuts, swelling or other injuries early. They should also have their doctor examine their feet at least once a year, and tell their doctor if they have pain.
diabetes Care, 2011 OCT.
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